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WO2000048523A1 - Distraction/contraction device for backbone osteosynthesis - Google Patents

Distraction/contraction device for backbone osteosynthesis Download PDF

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Publication number
WO2000048523A1
WO2000048523A1 PCT/FR2000/000414 FR0000414W WO0048523A1 WO 2000048523 A1 WO2000048523 A1 WO 2000048523A1 FR 0000414 W FR0000414 W FR 0000414W WO 0048523 A1 WO0048523 A1 WO 0048523A1
Authority
WO
WIPO (PCT)
Prior art keywords
connectors
rod
connector
pinion
rotation
Prior art date
Application number
PCT/FR2000/000414
Other languages
French (fr)
Inventor
Frédéric CONCHY
Denis Pasquet
Original Assignee
Dimso (Distribution Medicale Du Sud-Ouest)
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Dimso (Distribution Medicale Du Sud-Ouest) filed Critical Dimso (Distribution Medicale Du Sud-Ouest)
Priority to EP00906430A priority Critical patent/EP1152704B1/en
Priority to KR1020017010447A priority patent/KR20010102212A/en
Priority to JP2000599318A priority patent/JP2002537015A/en
Priority to AT00906430T priority patent/ATE275878T1/en
Priority to AU28109/00A priority patent/AU766743B2/en
Priority to US09/913,692 priority patent/US6749613B1/en
Priority to DE60013776T priority patent/DE60013776T2/en
Priority to CA002362247A priority patent/CA2362247C/en
Publication of WO2000048523A1 publication Critical patent/WO2000048523A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7014—Longitudinal elements, e.g. rods with means for adjusting the distance between two screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6408—Devices not permitting mobility, e.g. fixed to bed, with or without means for traction or reduction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks

Definitions

  • the present invention relates to instrumentation for spinal osteosynesis systems.
  • the surgeon is led to modify the distance separating the two vertebrae receiving the osteosynthesis system.
  • a conventional clamp called a distractor (used in the case where the vertebrae are to be moved away from each other) or called a contractor (used in the case where the vertebrae are closer to each other) is problematic or even impossible because of its size.
  • endoscopic instruments have too small strokes or do not allow applying sufficient effort to perform the distraction or contraction operation.
  • An object of the present invention is to provide a device allowing distraction and contraction of two vertebrae while being usable endoscopically and easy to use.
  • a distraction and / or contraction device for spine surgery comprising connectors capable of being fixed to respective vertebral anchoring members, means of junction between these connectors and means for adjusting a distance comprising a pinion and worm assembly.
  • the device makes it possible to effectively perform a distraction or a contraction between two vertebrae in a simple manner while retaining the displacement applied by a non-return effect without the intervention of
  • the means for adjusting a distance comprise a rod capable of connecting the connectors.
  • the rod is free in translation and rotation combined along its own axis relative to one of the connectors.
  • the rod is free to rotate along its own axis relative to the other of the connectors.
  • the rod is free in translation and rotation combined along its own axis relative to the other of the connectors with a helix of opposite direction.
  • the rod is locked in translation and in rotation along its own axis relative to one of the connectors.
  • the rod is free in translation along its own axis relative to the other of the connectors.
  • the pinion is rigidly secured to the rod.
  • the pinion forms a screw / nut connection with the rod.
  • the device comprises connecting means between the rod and the connectors, these connecting means comprising the pinion.
  • the device comprises connection means between the rod and the connectors, these connection means comprising a stud which forms a stop for the translational and / or rotational movement of the rod relative to the connector along the axis of the rod. .
  • the stud has a polygonal section, preferably on four sides.
  • At least one of the connectors has a bifurcated hook delimiting a space capable of receiving the rod and its connecting means.
  • the device can be dismantled into small elements, thus facilitating its use by the endoscopic route and its assembly.
  • the device is arranged so that, when the stud is received, one of the sides of the polygonal section of the stop is able to come into contact with the bottom of the space of the bifurcated hook.
  • one of the connectors comprises a ring with a spherical face.
  • the connector comprises a chamber capable of receiving the ring in rotation.
  • the connector comprises a lock capable of blocking the ring in rotation.
  • the lock comprises a concave spherical face capable of coming into contact with the spherical face of the ring.
  • one of the connectors is adjacent to the pinion and worm assembly.
  • the worm is able to be received in rotation in the connector.
  • the device further comprises an instrument, for the operation of the worm, capable of receiving the worm in rotation.
  • the instrument comprises a bifurcated hook, delimiting a space, capable of receiving the rod and the pinion rigidly secured to the rod.
  • a spinal osteosynthesis system comprising two vertebral anchoring members as well as a distraction and / or contraction device according to the present invention.
  • one of the connectors is capable of forming a ball joint connection with the associated vertebral anchoring member.
  • the device can be placed on anchoring members having alignment and parallelism defects.
  • the ring is capable of being mounted on the vertebral anchoring member.
  • FIG. 1 is a three-dimensional view of a first preferred embodiment
  • - Figure 2 is an exploded view of the first embodiment
  • FIGS. 3a and 3b are exploded views in three dimensions from two different angles of the first connector;
  • - Figure 3c is an axial sectional view of the first connector;
  • FIG. 5 is a top view of the first embodiment placed on a spine
  • FIG. 6 is a three-dimensional view of a second embodiment
  • FIG. 7a is a bottom view in three dimensions of a third embodiment.
  • FIGS. 1 to 5 are views in three dimensions of the third embodiment.
  • FIGS. 1 to 5 are views in three dimensions of the third embodiment.
  • the spinal osteosynthesis system comprises vertebral anchoring members here in the form of bicortical screws 2 each comprising a threaded body 4 and a cylindrical head 6 surmounting a flange 8.
  • the cylindrical head 6 has a smooth external face 10 forming a cylinder with an axis that of the bicortical screw 2.
  • the device For each pair of bicortical screws 2 each situated on a vertebral body 100, 200, the device comprises a first connector 12, a rod 14, a second connector 16 as well as drive means 18 and 20.
  • the first connector 12 consists of a body 26 and a receiving hook 28.
  • the body 26 is of generally parallelepiped shape with a cylindrical rear face 27 of semicircular section of diameter equal to the side of the parallelepiped.
  • the body 26 is traversed from its upper face 42 to its lower face 43 by a cylindrical orifice 30 of circular section consisting of an upper part 31 and a lower part 32.
  • the upper part 31 is a tapped hole whose thread is complementary to the thread 34 of a lock 22 allowing the latter to engage in the orifice 30.
  • the lower part 32 has a smooth hole with a housing 33 formed by a recess of circular section coaxial with the orifice 30 making it possible to receive and keep captive a ring or an olivette 24.
  • the olivette 24 has a smooth outer face 36 of spherical shape with the same radius as that of said recess 33 as well as a smooth inner face 38, rather of cylindrical shape of the same diameter as the smooth outer face 10 of the bicortical screw 2.
  • the olivette 24 comprises a straight slot 40 going from the external face 36 to the internal face 38 and this over the entire length of the olivette 24. It further comprises a groove 41 diametrically opposite to the slot 40 and located on the face external 36. A lip 44 retaining protrudes from the underside of the olivette 24.
  • This lip 44 prevents the opening of the orifice delimited by the internal face 38 of the olivette 24 from being masked by the rotation of said olivette 24 in its housing 33, which would prevent the connector 12 from being mounted on the head of the bicortical screw 2.
  • the latch 22 comprises an upper planar face 46 and a lower hemispherical concave face 48 substantially of the same diameter as the spherical face 36 of the olivette 24 and coming to cover the latter during assembly.
  • a hexagonal imprint 50 starts from the upper face 46 and opens onto the lower face 48 allowing the adaptation of a drive means for setting the lock 22 in motion with the aim of screwing it or unscrewing it.
  • the receiving hook 28 is bifurcated. It consists of two hooks 28a, 28b in the shape of a "U" separated by a space 52.
  • the branches of the "U” are parallel to each other and parallel to the axis 53 of the orifice 30.
  • the bottom 56 of the hooks is circular to receive the rod 14 when using the device.
  • the space 52 is delimited by a bearing face 58 parallel to the axis 53 of the orifice 30, on the one hand, and, on the other hand, of the circular bottom 56 of the hooks 28a, 28b.
  • the space 52 is also delimited by the faces 52a and 52b forming the sides of the respective hooks 28a and 28b.
  • the space 52 is configured so as to allow the insertion of a stud 60 of square section, one of the sides 61 of which is in contact with the bearing face 58, thus blocking the stud 60 in rotation.
  • the faces 52a and 52b cancel, for their part, the translations along the axis of the receiving hook.
  • the rod 14 has a thread 62 which engages with the thread of the stud 60, the latter then acting as a nut, screwing and unscrewing according to the movements of the rod 14.
  • a gripping orifice 64 precedes a pinion 18 integral with the rod 14.
  • the gripping orifice 64 allows the manipulation of the rod 14 during the endoscopic operating mode.
  • the drive means comprise, in addition to the pinion 18, an endless screw 20.
  • the endless screw 20 comprises at least one driving thread 21.
  • the pinion 18 is helical with a helix angle corresponding to the slope of the threads 21 for driving the worm 20 (angle between 5 ° and 25 °).
  • This imprint 68 opens into a circular chamber 70 which extends to the lower face 72 of the endless screw 20.
  • This circular chamber 70 has a diameter corresponding to the diameter of the external face 10 of the head 6 of the bicortical screw 2 so that the latter can be accommodated therein without difficulty and without disturbing the rotational movement of the endless screw 20.
  • the axis of the cavity 68 and the axis of the circular chamber 70 are coincident with the axis 67 of the auger 20.
  • the second connector 16 differs from the first connector 12 in that it comprises: - in place of the orifice 30 of the body 26 a circular chamber 72 which can receive the worm 20: its diameter is slightly greater than that of the worm 20 and its depth is equal to the height of the worm 20. From the bottom 73 of this receiving chamber 72, a coaxial hole 74 is drilled so as to lead to the underside 80 of the second connector 16 The diameter of this hole 74 is identical to that of the circular chamber 70 of the worm 20 in order to allow the passage of the head 6 of the bicortical screw 2.
  • a bifurcated receiving hook 72 whose branches 74.75 of the "U” form an angle ⁇ with the axis 67 of the receiving chamber 72 so that the opening of the "U” is towards the body 26 of the connector 16.
  • This angle ⁇ is between 5 ° and
  • the space 78 between the two hooks 72a, 72b is delimited by the faces 78a and 78b forming the sides of the hooks 72a and 72b respectively.
  • This space 78 enters the receiving chamber 72 of the worm 20 at least the depth of the threads 21 of said worm 20 without overflowing into the hole 74.
  • the opening of the space 78 is equal to the thickness of the pinion 18 that said space 78 receives.
  • the olivette 24 is mounted in its housing 33 located in the body 26 of the first connector 12 and the latch 22 is engaged in the upper part 31 tapped from the orifice 30 loosely to leave the olivette 24 free of movement within its housing 33.
  • the stud 60 is engaged on the threaded end 62 of the rod 14 and the pinion 18 on the opposite end beyond the gripping orifice 64. The entire device is introduced into the patient's body by the first approach.
  • the first connector 12 with its olivette 24 and its latch 22 is mounted on the head 6 of the first bicortical screw 2 so that it is completely trapped in the olivette 24, and that the internal face 38 of said olivette 24 is in contact with the external face 10 of the head 6 of the bicortical screw 2 and the projecting lip 44 in contact with the flange 8 of the screw 2.
  • the second connector 16 is then fully engaged on the head 6 of the second of the bicortical screws 2 through the hole 74.
  • the underside 80 of the connector 16 is in contact with the flange 8 of the screw 2.
  • the rod 14 is then introduced, held by its gripping orifice 64, then positioned at the bottom of the bifid hooks 28, 72 of the first 12 and second 16 connectors respectively of so that: - the stud 60 is inserted into the space 52 of the first connector 12, and with one of its faces 61 in contact with the bearing face 58, the pinion 18 is inserted into the space 78 of the second connector 16, the teeth protruding at the inside the receiving chamber 72 of the worm 20.
  • the lock 22 is then tightened.
  • the face 36 of the olivette 24 then slides on the lower face 48 of the lock 22 forcing, thanks to the presence of the slot 40 and the groove 41, the olivette 24 therefore to close at tighten on the head 6 of the bicortical screw 2, blocking the assembly of the connector 12 in position on the said screw 2.
  • the worm 20 is then positioned in the receiving chamber 72 of the second connector 16, the threads 21 coming in engagement with the teeth of the pinion 18.
  • the device is then ready to perform a distraction or a contraction by rotating movement of the worm 20 within the receiving chamber 72 of the second connector 16.
  • the latter comes to bear against the face 52a of the first connector 12 then that the pinion 18 comes to bear on the face 78b of the second connector 16.
  • the two connectors are forced to move away from each other, driving the bicortical screws 2 and the vertebrae 100,200 where the screws 2 are anchored.
  • the rod 14 driven in rotation by the pinion 18 maneuvered by the worm 20 is screwed into the stud 60.
  • the latter comes to bear against the face 52b of the first connector while the pinion 18 comes in support on the face 78a of the second connector 16.
  • the two connectors are forced to approach one another, driving the bicortical screws 2 and the vertebrae 100, 200 where the screws 2 are anchored.
  • the pinion 18 can neither extract nor extract the rod 14 due to the angle ⁇ of the branches 74, 75 of the "U" of the receiving hook 72 of the second connector 16 which presses, via the rod 14, the pinion 18 against the worm 20 without possibility of escape.
  • a spinal osteosynthesis system between these vertebrae is put in place between these vertebrae, such as, for example, intersommatic cages, then the device object of the body is extracted from the patient's body the present invention.
  • the arthrodesis is finalized by the installation on the anchoring organs of a second osteosynthesis system, such as, for example, an anterior fixation device, which will ensure the stability of the spinal segment thus instrumented during the setting of the fusion by means of the first osteosynthesis system.
  • the stud 60a is integral with the rod 14 blocking said rod 14 in rotation and in translation in the direction of its own axis relative to the first connector 12 the pinion 18a behaves like a nut whose thread is in engagement with that 62 of the rod 14.
  • the first 12 and second 16 connectors are identical to those described in the first embodiment.
  • the mounting of these connectors 12, 16 and of the rod 14 is similar too.
  • the rod 14 is stationary in rotation and it is the pinion 18a which, by screwing or unscrewing on the rod 14, performs the variations in distance between the two connectors 12, 16 of the device.
  • the third embodiment is illustrated in Figures 7a and 7b.
  • the connectors placed on the heads 6 of bicortical screws 2 are identical to the first connector 12 described in the aforementioned first embodiment.
  • the pinion 18 is integral with the rod 140 and is located in the middle of the rod 140.
  • the ends of the rod 140 each have a thread 141, 142. The directions of these threads are opposite with respect to each other.
  • a stud 600a, 600b comprising the complementary thread is engaged on each of these threads 141, 142.
  • the system comprises a connector 160 located at the end of a body 102 of instrument 100, similar to the second connector 16 described in the first embodiment mentioned above except as regards the direction of the branches of the “U” of the receiving hook 720 which are parallel to the axis of the receiving chamber.
  • the body 102 of the instrument 100 is connected to the connector 160 at the level of its body 260.
  • the system comprises an endless screw 200 secured to a drive means 202 passing through the body 102 of the instrument 100.
  • the connectors 12 are put in place as before.
  • the rod 140 is then installed in the receiving hooks 28 of said connectors 12 so that the pads 600a, 600b are in the space 52 between the respective receiving hooks 28 bifides as described above.
  • the instrument 100 is then positioned on the rod 140 at the pinion 18, the latter being placed in the space 780 of the receiving hook 720 bifid of the connector 160 of the instrument 100.
  • the pinion 18 is engaged with the worm screw threads 200.
  • the rod 140 driven in rotation by the pinion 18, itself apart from the worm 20, unscrews simultaneously in the two studs 600a, 600b which move away from each other causing the connectors 12 in distraction.
  • the rod 140 driven in rotation by the pinion 18 mu by the endless screw 20, is screwed simultaneously in the two studs 600a, 600b which approach each other causing the connectors 12 to contract .
  • the stud is of polygonal section in general; the stud is of circular section; the first connector comprises a hole threaded right through instead of the bifurcated receiving hook and the stud; - the rod is secured to the first connector in place of the bifurcated hook and the stud; or that the second connector has a ball joint with its anchoring member.
  • the anchoring members can be pedicle screws or else hooks.
  • the system will preferably be arranged to be mechanically irreversible at the level of the gears between the parts.
  • the worm 20 is actuated to move the anchoring members to the vertebrae. But no stress on the latter can in return move the parts, in particular the worm, in the opposite direction. It is the same in the second mode.
  • the drive means 202 makes it possible to move the two anchoring members to the vertebrae, but not the opposite.
  • the conditions for obtaining such irreversibility are known per se in other fields. Irreversibility depends in particular on the inclination of the teeth and the threads of the meshing pieces.

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Abstract

The invention concerns a distraction and/or contraction device for backbone surgery, comprising connectors (12, 16) designed to be fixed to respective vertebral anchoring members (2), linkup means between said connectors and means for adjusting the distance between said connectors including a pinion assembly (18, 18a) and an endless screw (20, 200).

Description

« DISPOSITIF DE DISTRACTION/CONTRACTION POUR SYSTEME "DISTRACTION / CONTRACTION DEVICE FOR SYSTEM
D ' OS TEOS YNTHESE RACHIDIENNE » . La présente invention concerne une instrumentation pour des systèmes d' ostéosynt èse rachidienne. Lors de la mise en place d'un système d' ostéosynthèse rachidienne, le chirurgien est amené à modifier la distance séparant les deux vertèbres recevant le système d' ostéosynthèse. De plus, lors des mises en place par voie endoscopique, l'utilisation d'une pince classique dite distractrice (utilisée dans le cas où les vertèbres sont à éloigner l'une de l'autre) ou dite contractrice (utilisée dans le cas où les vertèbres sont à rapprocher l'une de l'autre) est problématique voire impossible du fait de son encombrement. D'autre part, les instruments endoscopiques ont des courses trop faibles ou ne permettent pas d'appliquer d'efforts suffisants pour réaliser l'opération de distraction ou de contraction.OF OS TEOS YNTHESE RACHIDIENNE ". The present invention relates to instrumentation for spinal osteosynesis systems. During the installation of a spinal osteosynthesis system, the surgeon is led to modify the distance separating the two vertebrae receiving the osteosynthesis system. In addition, during endoscopic placement, the use of a conventional clamp called a distractor (used in the case where the vertebrae are to be moved away from each other) or called a contractor (used in the case where the vertebrae are closer to each other) is problematic or even impossible because of its size. On the other hand, endoscopic instruments have too small strokes or do not allow applying sufficient effort to perform the distraction or contraction operation.
Par ailleurs, le document DE 91 12 466 U nous enseigne une instrumentation permettant de positionner deux vis pédiculaires l'une par rapport à l'autre. Cette instrumentation est composée de deux bras s' interfaçant avec les vis pédiculaires et reliés entre eux par deux dispositifs de déplacement présentant chacun deux filetages en sens opposés en prise avec les bras respectifs. L'ensemble de l'instrumentation est très volumineux ce qui la rend inutilisable par voie chirurgicale endoscopique.In addition, the document DE 91 12 466 U teaches us an instrumentation making it possible to position two pedicle screws relative to each other. This instrumentation is composed of two arms interfacing with the pedicle screws and interconnected by two displacement devices each having two threads in opposite directions engaged with the respective arms. The entire instrumentation is very large which makes it unusable by endoscopic surgery.
Un but de la présente invention est de fournir un dispositif permettant la distraction et la contraction de deux vertèbres tout en étant utilisable par voie endoscopique et simple d'utilisation. Selon la présente invention, on prévoit, en vue de réaliser ce but, un dispositif de distraction et/ou de contraction pour la chirurgie du rachis comportant des connecteurs aptes à être fixés à des organes d' ancrage vertébral respectifs, des moyens de jonction entre ces connecteurs et des moyens de réglages d'une distance comprenant un assemblage à pignon et vis sans fin.An object of the present invention is to provide a device allowing distraction and contraction of two vertebrae while being usable endoscopically and easy to use. According to the present invention, in order to achieve this aim, a distraction and / or contraction device for spine surgery is provided, comprising connectors capable of being fixed to respective vertebral anchoring members, means of junction between these connectors and means for adjusting a distance comprising a pinion and worm assembly.
Ainsi, le dispositif permet de réaliser effectivement une distraction ou une contraction entre deux vertèbres de manière simple tout en conservant le déplacement appliqué par un effet anti-retour sans intervention deThus, the device makes it possible to effectively perform a distraction or a contraction between two vertebrae in a simple manner while retaining the displacement applied by a non-return effect without the intervention of
1' opérateur.1 operator.
Avantageusement, les moyens de réglage d'une distance comprennent une tige apte à relier les connecteurs. Avantageusement, la tige est libre en translation et rotation conjuguées selon son axe propre par rapport à l'un des connecteurs.Advantageously, the means for adjusting a distance comprise a rod capable of connecting the connectors. Advantageously, the rod is free in translation and rotation combined along its own axis relative to one of the connectors.
Avantageusement, la tige est libre en rotation selon son axe propre par rapport à l'autre des connecteurs. Avantageusement, la tige est libre en translation et rotation conjuguées selon son propre axe par rapport à l'autre des connecteurs avec une hélice de sens opposée.Advantageously, the rod is free to rotate along its own axis relative to the other of the connectors. Advantageously, the rod is free in translation and rotation combined along its own axis relative to the other of the connectors with a helix of opposite direction.
Avantageusement, la tige est bloquée en translation et en rotation suivant son axe propre par rapport à l'un des connecteurs.Advantageously, the rod is locked in translation and in rotation along its own axis relative to one of the connectors.
Avantageusement, la tige est libre en translation selon son axe propre par rapport à l'autre des connecteurs .Advantageously, the rod is free in translation along its own axis relative to the other of the connectors.
Avantageusement, le pignon est rigidement solidaire de la tige.Advantageously, the pinion is rigidly secured to the rod.
Avantageusement, le pignon forme une liaison vis/écrou avec la tige. Avantageusement, le dispositif comporte des moyens de liaison entre la tige et les connecteurs, ces moyens de liaison comprenant le pignon.Advantageously, the pinion forms a screw / nut connection with the rod. Advantageously, the device comprises connecting means between the rod and the connectors, these connecting means comprising the pinion.
Avantageusement, le dispositif comporte des moyens de liaison entre la tige et les connecteurs, ces moyens de liaison comprenant un plot qui forme butée pour le mouvement de translation et/ou de rotation de la tige par rapport au connecteur selon l'axe de la tige.Advantageously, the device comprises connection means between the rod and the connectors, these connection means comprising a stud which forms a stop for the translational and / or rotational movement of the rod relative to the connector along the axis of the rod. .
Avantageusement, le plot présente une section polygonale, de préférence à quatre cotés.Advantageously, the stud has a polygonal section, preferably on four sides.
Avantageusement, l'un au moins des connecteurs présente un crochet bifide délimitant un espace apte à recevoir la tige et ses moyens de liaison.Advantageously, at least one of the connectors has a bifurcated hook delimiting a space capable of receiving the rod and its connecting means.
Ainsi le dispositif est démontable en petits éléments, facilitant ainsi son utilisation par voie endoscopique et son assemblage.Thus, the device can be dismantled into small elements, thus facilitating its use by the endoscopic route and its assembly.
Avantageusement, le dispositif est agencé de sorte que, lorsque le plot est reçu, l'un des cotés de la section polygonale de la butée est apte à venir en contact avec le fond de l'espace du crochet bifide.Advantageously, the device is arranged so that, when the stud is received, one of the sides of the polygonal section of the stop is able to come into contact with the bottom of the space of the bifurcated hook.
Avantageusement, l'un des connecteurs comprend une bague à face sphérique.Advantageously, one of the connectors comprises a ring with a spherical face.
Avantageusement, le connecteur comprend une chambre apte à recevoir à rotation la bague. Avantageusement, le connecteur comprend un verrou apte à bloquer en rotation la bague.Advantageously, the connector comprises a chamber capable of receiving the ring in rotation. Advantageously, the connector comprises a lock capable of blocking the ring in rotation.
Avantageusement, le verrou comprend une face sphérique concave apte à venir en contact avec la face sphérique de la bague. Avantageusement, l'un des connecteurs est adjacent à l'assemblage à pignon et vis sans fin. Avantageusement, la vis sans fin est apte à être reçue à rotation dans le connecteur.Advantageously, the lock comprises a concave spherical face capable of coming into contact with the spherical face of the ring. Advantageously, one of the connectors is adjacent to the pinion and worm assembly. Advantageously, the worm is able to be received in rotation in the connector.
Avantageusement, le dispositif comporte en outre un instrument, en vue de la manœuvre de la vis sans fin, apte à recevoir à rotation le vis sans fin.Advantageously, the device further comprises an instrument, for the operation of the worm, capable of receiving the worm in rotation.
Avantageusement, l'instrument comprend un crochet bifide, délimitant un espace, apte à recevoir la tige et le pignon rigidement solidaire de la tige.Advantageously, the instrument comprises a bifurcated hook, delimiting a space, capable of receiving the rod and the pinion rigidly secured to the rod.
On prévoit aussi un système d' ostéosynthèse rachidienne comprenant deux organes d'ancrage vertébral ainsi qu'un dispositif de distraction et/ou de contraction selon la présente invention.A spinal osteosynthesis system is also provided, comprising two vertebral anchoring members as well as a distraction and / or contraction device according to the present invention.
Avantageusement, l'un des connecteurs est apte à former une liaison rotule avec l'organe d'ancrage vertébral associé.Advantageously, one of the connectors is capable of forming a ball joint connection with the associated vertebral anchoring member.
Ainsi, le dispositif peut être mis en place sur des organes d'ancrage présentant des défauts d'alignement et de parallélisme.Thus, the device can be placed on anchoring members having alignment and parallelism defects.
Avantageusement, la bague est apte à être montée sur l'organe d'ancrage vertébral.Advantageously, the ring is capable of being mounted on the vertebral anchoring member.
On prévoit aussi une méthode chirurgicale destinée à effectuer une ostéosynthèse rachidienne à l'aide d'un tel système d' ostéosynthèse comprenant un dispositif de distraction et/ou de contraction selon la présente invention : mise en place des organe d'ancrage sur les vertèbres, puis mise en place du dispositif sur les organes d'ancrage et réglage de la distance, puis mise en place du système d' ostéosynthèse, puis retrait du dispositif . D'autres caractéristiques et avantages de l'invention apparaîtront encore dans la description suivante de trois mode de réalisation préférés donnés à titre d'exemples non limitatifs. Aux dessins annexés :There is also provision for a surgical method intended to perform a spinal osteosynthesis using such an osteosynthesis system comprising a distraction and / or contraction device according to the present invention: placement of anchoring members on the vertebrae , then installation of the device on the anchoring members and adjustment of the distance, then installation of the osteosynthesis system, then removal of the device. Other characteristics and advantages of the invention will appear in the following description of three preferred embodiment given by way of nonlimiting examples. In the accompanying drawings:
-la figure 1 est une vue en trois dimensions d'un premier mode de réalisation préféré ; - la figure 2 est une vue éclatée du premier mode de réalisation ;FIG. 1 is a three-dimensional view of a first preferred embodiment; - Figure 2 is an exploded view of the first embodiment;
- les figures 3a et 3b sont des vues éclatées en trois dimensions sous deux angles différents du premier connecteur ; - la figure 3c est une vue en coupe axiale du premier connecteur ;- Figures 3a and 3b are exploded views in three dimensions from two different angles of the first connector; - Figure 3c is an axial sectional view of the first connector;
- les figures 4a et 4b sont des vues éclatées en trois dimensions sous deux angles différents du second connecteur ; - la figure 4c est une vue en coupe axiale du second connecteur ;- Figures 4a and 4b are exploded views in three dimensions from two different angles of the second connector; - Figure 4c is an axial sectional view of the second connector;
- la figure 5 est vue de dessus du premier mode de réalisation mise en place sur une colonne vertébrale ;- Figure 5 is a top view of the first embodiment placed on a spine;
-la figure 6 est une vue en trois dimensions d'un deuxième mode de réalisation ;FIG. 6 is a three-dimensional view of a second embodiment;
- la figure 7a est une vue par le dessous en trois dimensions d'un troisième mode de réalisation ; et- Figure 7a is a bottom view in three dimensions of a third embodiment; and
- la figure 7b est une vue de dessus en trois dimensions du troisième mode de réalisation. Nous allons décrire un premier mode de réalisation de la présente invention annexé aux figures 1 à 5.- Figure 7b is a top view in three dimensions of the third embodiment. We will describe a first embodiment of the present invention annexed to FIGS. 1 to 5.
Le système d' ostéosynthèse rachidienne comprend des organes d'ancrage vertébraux ici sous la forme de vis bicorticales 2 comprenant chacune un corps fileté 4 et une tête cylindrique 6 surmontant une collerette 8. La tête cylindrique 6 présente une face externe lisse 10 formant un cylindre d'axe celui de la vis bicorticale 2.The spinal osteosynthesis system comprises vertebral anchoring members here in the form of bicortical screws 2 each comprising a threaded body 4 and a cylindrical head 6 surmounting a flange 8. The cylindrical head 6 has a smooth external face 10 forming a cylinder with an axis that of the bicortical screw 2.
Pour chaque paire de vis bicorticales 2 situées chacune sur un corps vertébral 100, 200, le dispositif comprend un premier connecteur 12, une tige 14, un deuxième connecteur 16 ainsi que des moyens d'entraînement 18 et 20.For each pair of bicortical screws 2 each situated on a vertebral body 100, 200, the device comprises a first connector 12, a rod 14, a second connector 16 as well as drive means 18 and 20.
Le premier connecteur 12 est constitué d'un corps 26 et d'un crochet de réception 28. Le corps 26 est de forme générale parallélépipèdique avec une face arrière 27 cylindrique de section hémicirculaire de diamètre égal au coté du parallélépipède. Le corps 26 est traversé de sa face supérieure 42 à sa face inférieure 43 par un orifice 30 cylindrique de section circulaire constitué d'une partie supérieure 31 et d'une partie inférieure 32. La partie supérieure 31 est un trou taraudé dont le filetage est complémentaire du filetage 34 d'un verrou 22 permettant à ce dernier de s'engager dans l'orifice 30. La partie inférieure 32 comporte un trou lisse avec un logement 33 réalisé par un chambrage de section circulaire coaxial avec l'orifice 30 permettant de recevoir et de maintenir prisonnière une bague ou une olivette 24.The first connector 12 consists of a body 26 and a receiving hook 28. The body 26 is of generally parallelepiped shape with a cylindrical rear face 27 of semicircular section of diameter equal to the side of the parallelepiped. The body 26 is traversed from its upper face 42 to its lower face 43 by a cylindrical orifice 30 of circular section consisting of an upper part 31 and a lower part 32. The upper part 31 is a tapped hole whose thread is complementary to the thread 34 of a lock 22 allowing the latter to engage in the orifice 30. The lower part 32 has a smooth hole with a housing 33 formed by a recess of circular section coaxial with the orifice 30 making it possible to receive and keep captive a ring or an olivette 24.
L'olivette 24 comporte une face externe 36 lisse de forme sphérique de même rayon que celui du dit chambrage 33 ainsi qu'une face interne 38 lisse, plutôt de forme cylindrique de même diamètre que la face externe lisse 10 de la vis bicorticale 2. L'olivette 24 comprend une fente 40 droite allant de la face externe 36 à la face interne 38 et ce sur toute la longueur de l'olivette 24. Elle comprend en outre une rainure 41 diamétralement opposée à la fente 40 et située sur la face externe 36. Une lèvre 44 de retenue fait saillie sur la face inférieure de l'olivette 24. Cette lèvre 44 évite que l'ouverture de l'orifice délimité par la face interne 38 de l'olivette 24 soit masquée par la rotation de la dite olivette 24 dans son logement 33, ce qui empêcherait le montage du connecteur 12 sur la tête de la vis bicorticale 2.The olivette 24 has a smooth outer face 36 of spherical shape with the same radius as that of said recess 33 as well as a smooth inner face 38, rather of cylindrical shape of the same diameter as the smooth outer face 10 of the bicortical screw 2. The olivette 24 comprises a straight slot 40 going from the external face 36 to the internal face 38 and this over the entire length of the olivette 24. It further comprises a groove 41 diametrically opposite to the slot 40 and located on the face external 36. A lip 44 retaining protrudes from the underside of the olivette 24. This lip 44 prevents the opening of the orifice delimited by the internal face 38 of the olivette 24 from being masked by the rotation of said olivette 24 in its housing 33, which would prevent the connector 12 from being mounted on the head of the bicortical screw 2.
Le verrou 22 comprend une face supérieure 46 plane et une face inférieure 48 hémisphérique concave sensiblement de même diamètre que la face sphérique 36 de l'olivette 24 et venant coiffer cette dernière lors du montage. Une empreinte 50 hexagonale part de la face supérieure 46 et débouche sur la face inférieure 48 permettant l'adaptation d'un moyen d'entraînement pour la mise en mouvement du verrou 22 dans le but de le visser ou de le dévisser.The latch 22 comprises an upper planar face 46 and a lower hemispherical concave face 48 substantially of the same diameter as the spherical face 36 of the olivette 24 and coming to cover the latter during assembly. A hexagonal imprint 50 starts from the upper face 46 and opens onto the lower face 48 allowing the adaptation of a drive means for setting the lock 22 in motion with the aim of screwing it or unscrewing it.
Le crochet de réception 28 est bifide. Il est constitué de deux crochets 28a, 28b en forme de « U » séparés par un espace 52. Les branches du « U » sont parallèle entre elles et parallèles à l'axe 53 de l'orifice 30. Le fond 56 des crochets est circulaire pour recevoir la tige 14 lors de l'utilisation du dispositif. L'espace 52 est délimité par une face d'appui 58 parallèle à l'axe 53 de l'orifice 30, d'une part, et, d'autre part, du fond 56 circulaire des crochets 28a, 28b. L'espace 52 est délimité aussi par les faces 52a et 52b formant les cotés des crochets 28a et 28b respectifs. Ainsi, l'espace 52 est configuré de manière à permettre l'insertion d'un plot 60 de section carrée dont l'un des côtés 61 est en contact avec la face d'appui 58, bloquant ainsi le plot 60 en rotation. Les faces 52a et 52b annulent, quant à elles, les translations selon l'axe du crochet de réception. Dans ce mode préféré de réalisation, la tige 14 présente un filetage 62 qui vient en prise avec le filetage du plot 60, ce dernier faisant alors office d'écrou, se vissant et se dévissant suivant les mouvements de la tige 14. A l'autre extrémité de la tige 14, un orifice 64 de préhension précède un pignon 18 solidaire de la tige 14. L'orifice 64 de préhension permet la manipulation de la tige 14 lors du mode opératoire en voie endoscopique. Les moyens d'entraînement comprennent, en plus du pignon 18, une vis sans fin 20. La vis sans fin 20 comporte au moins un filet 21 d'entraînement.The receiving hook 28 is bifurcated. It consists of two hooks 28a, 28b in the shape of a "U" separated by a space 52. The branches of the "U" are parallel to each other and parallel to the axis 53 of the orifice 30. The bottom 56 of the hooks is circular to receive the rod 14 when using the device. The space 52 is delimited by a bearing face 58 parallel to the axis 53 of the orifice 30, on the one hand, and, on the other hand, of the circular bottom 56 of the hooks 28a, 28b. The space 52 is also delimited by the faces 52a and 52b forming the sides of the respective hooks 28a and 28b. Thus, the space 52 is configured so as to allow the insertion of a stud 60 of square section, one of the sides 61 of which is in contact with the bearing face 58, thus blocking the stud 60 in rotation. The faces 52a and 52b cancel, for their part, the translations along the axis of the receiving hook. In this preferred embodiment, the rod 14 has a thread 62 which engages with the thread of the stud 60, the latter then acting as a nut, screwing and unscrewing according to the movements of the rod 14. other end of the rod 14, a gripping orifice 64 precedes a pinion 18 integral with the rod 14. The gripping orifice 64 allows the manipulation of the rod 14 during the endoscopic operating mode. The drive means comprise, in addition to the pinion 18, an endless screw 20. The endless screw 20 comprises at least one driving thread 21.
La pignon 18 est hélicoïdal avec un angle d'hélice correspondant à la pente des filets 21 d'entraînement de la vis sans fin 20 (angle compris entre 5° et 25°) .The pinion 18 is helical with a helix angle corresponding to the slope of the threads 21 for driving the worm 20 (angle between 5 ° and 25 °).
De la face supérieure 66 de la vis sans fin 60, part une empreinte 68 hexagonale qui permet l'adaptation d'un moyen d'entraînement. Cette empreinte 68 débouche dans une chambre 70 circulaire qui s'étend jusqu'à la face inférieure 72 de la vis sans fin 20. Cette chambre circulaire 70 a un diamètre correspondant au diamètre de la face externe 10 de la tête 6 de la vis bicorticale 2 pour que cette dernière puisse s'y loger sans peine et sans perturber le mouvement en rotation de la vis sans fin 20. L'axe de l'empreinte 68 et l'axe de la chambre circulaire 70 sont confondus avec l'axe 67 de la vis sans fin 20.From the upper face 66 of the endless screw 60, leaves a hexagonal imprint 68 which allows the adaptation of a drive means. This imprint 68 opens into a circular chamber 70 which extends to the lower face 72 of the endless screw 20. This circular chamber 70 has a diameter corresponding to the diameter of the external face 10 of the head 6 of the bicortical screw 2 so that the latter can be accommodated therein without difficulty and without disturbing the rotational movement of the endless screw 20. The axis of the cavity 68 and the axis of the circular chamber 70 are coincident with the axis 67 of the auger 20.
Le deuxième connecteur 16 se différencie du premier connecteur 12 en ce qu' il comporte : - en lieu et place de l'orifice 30 du corps 26 une chambre circulaire 72 pouvant recevoir la vis sans fin 20 : son diamètre est légèrement supérieur à celui de la vis sans fin 20 et sa profondeur est égale à la hauteur de la vis sans fin 20. Du fond 73 de cette chambre de réception 72, un trou 74 coaxial est percé de manière à déboucher sur la face inférieure 80 du second connecteur 16. Le diamètre de ce trou 74 est identique à celui de la chambre circulaire 70 de la vis sans fin 20 dans le but de permettre le passage de la tête 6 de la vis bicorticale 2.The second connector 16 differs from the first connector 12 in that it comprises: - in place of the orifice 30 of the body 26 a circular chamber 72 which can receive the worm 20: its diameter is slightly greater than that of the worm 20 and its depth is equal to the height of the worm 20. From the bottom 73 of this receiving chamber 72, a coaxial hole 74 is drilled so as to lead to the underside 80 of the second connector 16 The diameter of this hole 74 is identical to that of the circular chamber 70 of the worm 20 in order to allow the passage of the head 6 of the bicortical screw 2.
Un crochet de réception 72 bifide dont les branches 74,75 du « U » forment un angle α avec l'axe 67 de la chambre de réception 72 de manière à ce que l'ouverture des « U » soit vers le corps 26 du connecteur 16. Cet angle α est compris entre 5° etA bifurcated receiving hook 72 whose branches 74.75 of the "U" form an angle α with the axis 67 of the receiving chamber 72 so that the opening of the "U" is towards the body 26 of the connector 16. This angle α is between 5 ° and
30°. L'espace 78 entre les deux crochets 72a, 72b est délimité par les faces 78a et 78b formants les côtés des crochets 72a et 72b respectivement. Cet espace 78 pénètre dans la chambre de réception 72 de la vis sans fin 20 d'au moins la profondeur des filets 21 de la dite vis sans fin 20 sans déborder sur le trou 74. L'ouverture de l'espace 78 est égal à l'épaisseur du pignon 18 que le dit espace 78 réceptionne.30 °. The space 78 between the two hooks 72a, 72b is delimited by the faces 78a and 78b forming the sides of the hooks 72a and 72b respectively. This space 78 enters the receiving chamber 72 of the worm 20 at least the depth of the threads 21 of said worm 20 without overflowing into the hole 74. The opening of the space 78 is equal to the thickness of the pinion 18 that said space 78 receives.
Initialement, l'olivette 24 est monté dans son logement 33 situé dans le corps 26 du premier connecteur 12 et le verrou 22 est engagé dans la partie supérieure 31 taraudée de l'orifice 30 de manière non serré pour laisser l'olivette 24 libre de mouvement au sein de son logement 33. Le plot 60 est engagé sur l'extrémité filetée 62 de la tige 14 et le pignon 18 sur l'extrémité opposée au delà de l'orifice de préhension 64. L'ensemble du dispositif est introduit dans le corps du patient par la voie d'abord pratiquée. Le premier connecteur 12 avec son olivette 24 et son verrou 22 est monté sur la tête 6 de la première des vis bicorticales 2 de manière à ce qu'elle soit complètement emprisonnée dans l'olivette 24, et que la face interne 38 de la dite olivette 24 soit en contact avec la face externe 10 de la tête 6 de la vis bicorticale 2 et la lèvre 44 en saillie en contact avec la collerette 8 de la vis 2. Le deuxième connecteur 16 est ensuite engagé complètement sur la tête 6 de la deuxième des vis bicorticales 2 par le trou 74. La face inférieure 80 du connecteur 16 est en contact avec la collerette 8 de la vis 2. La tige 14 est ensuite introduite, maintenue par son orifice de préhension 64, puis positionnée au fond des crochets bifides 28, 72 des premier 12 et deuxième 16 connecteurs respectivement de manière à ce que : - le plot 60 s'insère dans l'espace 52 du premier connecteur 12, et avec l'une de ses faces 61 en contact avec la face d'appui 58, le pignon 18 s'insère dans l'espace 78 du deuxième connecteur 16, les dents débordant à l'intérieur de la chambre de réception 72 de la vis sans fin 20.Initially, the olivette 24 is mounted in its housing 33 located in the body 26 of the first connector 12 and the latch 22 is engaged in the upper part 31 tapped from the orifice 30 loosely to leave the olivette 24 free of movement within its housing 33. The stud 60 is engaged on the threaded end 62 of the rod 14 and the pinion 18 on the opposite end beyond the gripping orifice 64. The entire device is introduced into the patient's body by the first approach. The first connector 12 with its olivette 24 and its latch 22 is mounted on the head 6 of the first bicortical screw 2 so that it is completely trapped in the olivette 24, and that the internal face 38 of said olivette 24 is in contact with the external face 10 of the head 6 of the bicortical screw 2 and the projecting lip 44 in contact with the flange 8 of the screw 2. The second connector 16 is then fully engaged on the head 6 of the second of the bicortical screws 2 through the hole 74. The underside 80 of the connector 16 is in contact with the flange 8 of the screw 2. The rod 14 is then introduced, held by its gripping orifice 64, then positioned at the bottom of the bifid hooks 28, 72 of the first 12 and second 16 connectors respectively of so that: - the stud 60 is inserted into the space 52 of the first connector 12, and with one of its faces 61 in contact with the bearing face 58, the pinion 18 is inserted into the space 78 of the second connector 16, the teeth protruding at the inside the receiving chamber 72 of the worm 20.
On serre alors le verrou 22. La face 36 de l'olivette 24 glisse alors sur la face inférieure 48 du verrou 22 forçant, grâce à la présence de la fente 40 et de la rainure 41, l'olivette 24 à se refermer donc à se resserrer sur la tête 6 de la vis bicorticale 2, bloquant l'ensemble du connecteur 12 en position sur la dite vis 2. La vis sans fin 20 est ensuite positionnée dans la chambre de réception 72 du second connecteur 16, les filets 21 venant en prise avec les dents du pignon 18. Le dispositif est alors prêt pour effectuer une distraction ou une contraction par mise en mouvement rotatif de la vis sans fin 20 au sein de la chambre de réception 72 du second connecteur 16.The lock 22 is then tightened. The face 36 of the olivette 24 then slides on the lower face 48 of the lock 22 forcing, thanks to the presence of the slot 40 and the groove 41, the olivette 24 therefore to close at tighten on the head 6 of the bicortical screw 2, blocking the assembly of the connector 12 in position on the said screw 2. The worm 20 is then positioned in the receiving chamber 72 of the second connector 16, the threads 21 coming in engagement with the teeth of the pinion 18. The device is then ready to perform a distraction or a contraction by rotating movement of the worm 20 within the receiving chamber 72 of the second connector 16.
Dans le cas de la distraction, la tige 14 entraînée en rotation par le pignon 18, lui-même manœuvré par la vis sans fin 20, se dévisse dans le plot 60. Ce dernier vient en appui contre la face 52a du premier connecteur 12 alors que le pignon 18 vient en appui sur la face 78b du second connecteur 16. Les deux connecteurs sont obligés de s'éloigner l'un de l'autre, entraînant les vis bicorticales 2 et les vertèbres 100,200 où les vis 2 sont ancrées .In the case of distraction, the rod 14 rotated by the pinion 18, itself operated by the worm 20, unscrews in the stud 60. The latter comes to bear against the face 52a of the first connector 12 then that the pinion 18 comes to bear on the face 78b of the second connector 16. The two connectors are forced to move away from each other, driving the bicortical screws 2 and the vertebrae 100,200 where the screws 2 are anchored.
Dans le cas de la contraction, la tige 14 entraînée en rotation par le pignon 18 manœuvré par la vis sans fin 20 se visse dans le plot 60. Ce dernier vient en appui contre la face 52b du premier connecteur alors que le pignon 18 vient en appui sur la face 78a du second connecteur 16. Les deux connecteurs sont obligés de se rapprocher l'un de l'autre, entraînant les vis bicorticales 2 et les vertèbres 100, 200 où les vis 2 sont ancrées.In the case of contraction, the rod 14 driven in rotation by the pinion 18 maneuvered by the worm 20 is screwed into the stud 60. The latter comes to bear against the face 52b of the first connector while the pinion 18 comes in support on the face 78a of the second connector 16. The two connectors are forced to approach one another, driving the bicortical screws 2 and the vertebrae 100, 200 where the screws 2 are anchored.
Lors de ces mouvements, le pignon 18 ne peut ni s'extraire ni extraire la tige 14 du fait de l'angle α des branches 74, 75 du « U » du crochet de réception 72 du second connecteur 16 qui plaquent, via la tige 14, le pignon 18 contre la vis sans fin 20 sans possibilité d' échappement .During these movements, the pinion 18 can neither extract nor extract the rod 14 due to the angle α of the branches 74, 75 of the "U" of the receiving hook 72 of the second connector 16 which presses, via the rod 14, the pinion 18 against the worm 20 without possibility of escape.
Une fois la distance désirée obtenue, on met en place entre les vertèbres un système d' ostéosynthèse rachidienne entre ces vertèbres comme, par exemple, des cages intersommatiques, puis on extrait du corps du patient par la voie d'abord pratiquée le dispositif objet de la présente invention. Enfin, l'arthrodèse est finalisée par la mise en place sur les organes d'ancrage d'un second système d' ostéosynthèse, comme, par exemple, un dispositif de fixation antérieure, qui assurera la stabilité du segment rachidien ainsi instrumenté durant la prise de la fusion au moyen du premier système d' ostéosynthèse .Once the desired distance has been obtained, a spinal osteosynthesis system between these vertebrae is put in place between these vertebrae, such as, for example, intersommatic cages, then the device object of the body is extracted from the patient's body the present invention. Finally, the arthrodesis is finalized by the installation on the anchoring organs of a second osteosynthesis system, such as, for example, an anterior fixation device, which will ensure the stability of the spinal segment thus instrumented during the setting of the fusion by means of the first osteosynthesis system.
Le deuxième de réalisation est illustré par la figureThe second embodiment is illustrated by the figure
6. Il diffère du premier mode de réalisation précité dans le fait que : - le plot 60a est solidaire de la tige 14 bloquant la dite tige 14 en rotation et en translation dans la direction de son propre axe par rapport au premier connecteur 12 le pignon 18a se comporte comme un écrou dont le filetage est en prise avec celui 62 de la tige 14.6. It differs from the aforementioned first embodiment in that: - the stud 60a is integral with the rod 14 blocking said rod 14 in rotation and in translation in the direction of its own axis relative to the first connector 12 the pinion 18a behaves like a nut whose thread is in engagement with that 62 of the rod 14.
Les premier 12 et second 16 connecteurs sont identiques à ceux décrits dans le premier mode de réalisation. Le montage de ces connecteurs 12, 16 et de la tige 14 est similaire aussi. Lors de la distraction ou de la contraction, la tige 14 est immobile en rotation et c'est le pignon 18a qui en se vissant ou en se dévissant sur la tige 14 effectue les variations de distance entre les deux connecteurs 12, 16 du dispositif.The first 12 and second 16 connectors are identical to those described in the first embodiment. The mounting of these connectors 12, 16 and of the rod 14 is similar too. During distraction or contraction, the rod 14 is stationary in rotation and it is the pinion 18a which, by screwing or unscrewing on the rod 14, performs the variations in distance between the two connectors 12, 16 of the device.
Le troisième mode de réalisation est illustré par les figures 7a et 7b. Les connecteurs placés sur les têtes 6 de vis bicorticales 2 sont identiques au premier connecteur 12 décrit dans le premier mode de réalisation précité. Le pignon 18 est solidaire de la tige 140 et est situé au milieu de la tige 140. Les extrémités de la tige 140 comportent chacune un filetage 141, 142. Les sens de ces filetages sont opposés l'un par rapport à l'autre. Un plot 600a, 600b comportant le filetage complémentaire est engagé sur chacun de ces filetages 141, 142. Le système comprend un connecteur 160 situé à l'extrémité d'un corps 102 d'instrument 100, similaire au second connecteur 16 décrit dans le premier mode de réalisation précité sauf en ce qui concerne la direction des branches du « U » du crochet de réception 720 qui sont parallèles à l'axe de la chambre de réception. Le corps 102 de l'instrument 100 est relié au connecteur 160 au niveau de son corps 260. Le système comprend une vis sans fin 200 solidaire d'un moyen d'entraînement 202 passant au travers du corps 102 de l'instrument 100.The third embodiment is illustrated in Figures 7a and 7b. The connectors placed on the heads 6 of bicortical screws 2 are identical to the first connector 12 described in the aforementioned first embodiment. The pinion 18 is integral with the rod 140 and is located in the middle of the rod 140. The ends of the rod 140 each have a thread 141, 142. The directions of these threads are opposite with respect to each other. A stud 600a, 600b comprising the complementary thread is engaged on each of these threads 141, 142. The system comprises a connector 160 located at the end of a body 102 of instrument 100, similar to the second connector 16 described in the first embodiment mentioned above except as regards the direction of the branches of the “U” of the receiving hook 720 which are parallel to the axis of the receiving chamber. The body 102 of the instrument 100 is connected to the connector 160 at the level of its body 260. The system comprises an endless screw 200 secured to a drive means 202 passing through the body 102 of the instrument 100.
Les connecteurs 12 sont mis en place comme précédemment. La tige 140 est ensuite installée dans les crochets de réception 28 des dits connecteurs 12 de manière à ce que les plots 600a, 600b soient dans l'espace 52 entre les crochets de réception 28 bifides respectifs comme décrit précédemment. L'instrument 100 est alors positionné sur la tige 140 au niveau du pignon 18, ce dernier se plaçant dans l'espace 780 du crochet de réception 720 bifide du connecteur 160 de l'instrument 100. Le pignon 18 se trouve en prise avec les filets de la vis sans fin 200.The connectors 12 are put in place as before. The rod 140 is then installed in the receiving hooks 28 of said connectors 12 so that the pads 600a, 600b are in the space 52 between the respective receiving hooks 28 bifides as described above. The instrument 100 is then positioned on the rod 140 at the pinion 18, the latter being placed in the space 780 of the receiving hook 720 bifid of the connector 160 of the instrument 100. The pinion 18 is engaged with the worm screw threads 200.
Lors de la distraction, la tige 140, entraînée en rotation par le pignon 18, lui-même mu part la vis sans fin 20, se dévisse simultanément dans les deux plots 600a, 600b qui s'éloignent l'un de l'autre entraînant les connecteurs 12 en distraction.During distraction, the rod 140, driven in rotation by the pinion 18, itself apart from the worm 20, unscrews simultaneously in the two studs 600a, 600b which move away from each other causing the connectors 12 in distraction.
Lors de la contraction, la tige 140, entraînée en rotation par le pignon 18 mu par la vis sans fin 20, se visse simultanément dans les deux plots 600a, 600b qui se rapprochent l'un de l'autre entraînant les connecteurs 12 en contraction. Bien entendu, on pourra apporter à l'invention de nombreuse modifications sans sortir du cadre de celle-ci. On pourra prévoir que : le plot est de section polygonale de manière générale ; le plot est de section circulaire ; le premier connecteur comprend un trou fileté de part en part en lieu et place du crochet bifide de réception et du plot ; - la tige est solidaire du premier connecteur en lieu et place du crochet bifide et du plot ; ou encore que le deuxième connecteur a une liaison rotule avec son organe d'ancrage. Les organes d'ancrage peuvent être des vis pédiculaires ou bien des crochets.During the contraction, the rod 140, driven in rotation by the pinion 18 mu by the endless screw 20, is screwed simultaneously in the two studs 600a, 600b which approach each other causing the connectors 12 to contract . Of course, many modifications can be made to the invention without departing from the scope thereof. It can be provided that: the stud is of polygonal section in general; the stud is of circular section; the first connector comprises a hole threaded right through instead of the bifurcated receiving hook and the stud; - the rod is secured to the first connector in place of the bifurcated hook and the stud; or that the second connector has a ball joint with its anchoring member. The anchoring members can be pedicle screws or else hooks.
Dans chacun des exemples de réalisation qui précèdent, le système sera de préférence agencé pour être mécaniquement irréversible au niveau des engrenements entre les pièces. Ainsi, dans le premier mode, on actionne la vis sans fin 20 pour déplacer les organes d'ancrage aux vertèbres. Mais aucune sollicitation sur ces dernières ne peut en retour mouvoir les pièces, notamment la vis sans fin, en sens inverse. Il en est de même dans le deuxième mode. Dans le troisième mode, le moyen d'entraînement 202 permet de déplacer les deux organes d'ancrage aux vertèbres, mais pas le contraire. Les conditions pour l'obtention d'une telle irréversibilité sont connues en soi dans d' autres domaines. L'irréversibilité dépend notamment de l'inclinaison des dents et des filets des pièces en engrènement . In each of the preceding embodiments, the system will preferably be arranged to be mechanically irreversible at the level of the gears between the parts. Thus, in the first mode, the worm 20 is actuated to move the anchoring members to the vertebrae. But no stress on the latter can in return move the parts, in particular the worm, in the opposite direction. It is the same in the second mode. In the third mode, the drive means 202 makes it possible to move the two anchoring members to the vertebrae, but not the opposite. The conditions for obtaining such irreversibility are known per se in other fields. Irreversibility depends in particular on the inclination of the teeth and the threads of the meshing pieces.

Claims

REVENDICATIONS
1. Dispositif de distraction et/ou de contraction pour la chirurgie du rachis, comportant des connecteurs (12,16) aptes à être fixés à des organes (2) d'ancrage vertébral respectifs, des moyens de jonction entre ces connecteurs et des moyens de réglages d'une distance entre ces connecteurs, caractérisé en ce que les moyens de réglage comprennent un assemblage à pignon (18; 18a) et vis sans fin (20;200) .1. Distraction and / or contraction device for spine surgery, comprising connectors (12,16) able to be fixed to respective vertebral anchoring members (2), means of junction between these connectors and means for adjusting a distance between these connectors, characterized in that the adjustment means comprise a pinion assembly (18; 18a) and a worm screw (20; 200).
2. Dispositif selon la revendication 1 caractérisé en ce que les moyens de réglage d'une distance comprennent une tige (14;140) apte à relier les connecteurs (12,16).2. Device according to claim 1 characterized in that the means for adjusting a distance comprise a rod (14; 140) capable of connecting the connectors (12,16).
3. Dispositif selon la revendication 2 caractérisé en ce que la tige (14; 140) est libre en translation et rotation conjuguées selon son axe propre par rapport à l'un des connecteurs (12,16).3. Device according to claim 2 characterized in that the rod (14; 140) is free in translation and rotation combined along its own axis relative to one of the connectors (12,16).
4. Dispositif selon la revendication 3 caractérisé en ce que la tige (14) est libre en rotation selon son axe propre par rapport à l'autre des connecteurs (12,16).4. Device according to claim 3 characterized in that the rod (14) is free to rotate along its own axis relative to the other of the connectors (12,16).
5. Dispositif selon la revendication 3 caractérisé en ce que la tige (140) est libre en translation et rotation conjuguées selon son propre axe par rapport à l'autre des connecteurs (12,16) avec une hélice de sens opposée. 5. Device according to claim 3 characterized in that the rod (140) is free in translation and rotation combined along its own axis relative to the other of the connectors (12,16) with a helix of opposite direction.
6. Dispositif selon la revendication 2 caractérisé en ce que la tige (14) est bloquée en translation et en rotation suivant son axe propre par rapport à l'un des connecteurs (12,16).6. Device according to claim 2 characterized in that the rod (14) is blocked in translation and in rotation along its own axis relative to one of the connectors (12,16).
7. Dispositif selon la revendication 6 caractérisé en ce que la tige (14) est libre en translation selon son axe propre par rapport à l'autre des connecteurs (12,16). 7. Device according to claim 6 characterized in that the rod (14) is free in translation along its own axis relative to the other of the connectors (12,16).
8. Dispositif selon la revendication 3, 4 ou 5 caractérisé en ce que le pignon (18) est rigidement solidaire de la tige (14;140).8. Device according to claim 3, 4 or 5 characterized in that the pinion (18) is rigidly secured to the rod (14; 140).
9. Dispositif selon la revendication 6 ou 7 caractérisé en ce que le pignon (18a) forme une liaison vis/écrou avec la tige (14) .9. Device according to claim 6 or 7 characterized in that the pinion (18a) forms a screw / nut connection with the rod (14).
10. Dispositif selon l'une des revendications 2 à 9 caractérisé en ce qu' il comporte des moyens de liaison entre la tige (14) et les connecteurs (12,16), ces moyens de liaison comprenant le pignon (18;18a).10. Device according to one of claims 2 to 9 characterized in that it comprises connecting means between the rod (14) and the connectors (12,16), these connecting means comprising the pinion (18; 18a) .
11. Dispositif selon l'une des revendications 2 à 10 caractérisé en ce qu' il comporte des moyens de liaison entre la tige (14; 140) et les connecteurs (12,16), ces moyens de liaison comprenant un plot (60; 600a, 600b) qui forme butée pour le mouvement de translation et/ou de rotation de la tige par rapport au connecteur selon l'axe de la tige.11. Device according to one of claims 2 to 10 characterized in that it comprises connecting means between the rod (14; 140) and the connectors (12,16), these connecting means comprising a stud (60; 600a, 600b) which forms a stop for the translational and / or rotational movement of the rod relative to the connector along the axis of the rod.
12. Dispositif selon la revendication 11 caractérisé en ce que le plot présente une section polygonale, de préférence à quatre cotés (61).12. Device according to claim 11 characterized in that the stud has a polygonal section, preferably on four sides (61).
13. Dispositif selon l'une des revendications 10 à 12 caractérisé en ce que l'un au moins des connecteurs13. Device according to one of claims 10 to 12 characterized in that at least one of the connectors
(12,16) présente un crochet (28,72) bifide délimitant un espace (52,78) apte à recevoir la tige (14; 140) et ses moyens de liaison (18; 18a; 60; 600a, 600b) avec le connecteur.(12,16) has a bifid hook (28,72) delimiting a space (52,78) capable of receiving the rod (14; 140) and its connecting means (18; 18a; 60; 600a, 600b) with the connector.
14. Dispositif selon les revendications 12 et 13 caractérisé en ce qu'il est agencé de sorte que, lorsque le plot (60; 600a, 600b) est reçu, l'un des cotés (61) de la section polygonale de la butée (60; 600a, 600b) est apte à venir en contact avec le fond (58) de l'espace (52) du crochet bifide (28) . 14. Device according to claims 12 and 13 characterized in that it is arranged so that, when the stud (60; 600a, 600b) is received, one of the sides (61) of the polygonal section of the stop ( 60; 600a, 600b) is capable of coming into contact with the bottom (58) of the space (52) of the bifurcated hook (28).
15. Dispositif selon l'une des revendications 2 à 14 caractérisé en ce que l'un des connecteurs (12,16) comprend une bague (24) à face sphérique.15. Device according to one of claims 2 to 14 characterized in that one of the connectors (12,16) comprises a ring (24) with a spherical face.
16. Dispositif selon la revendication 15 caractérisé en ce que le connecteur comprend une chambre (33) apte à recevoir à rotation la bague (24) .16. Device according to claim 15 characterized in that the connector comprises a chamber (33) capable of receiving the ring (24) in rotation.
17. Dispositif selon la revendication 15 ou 16 caractérisé en ce que le connecteur comprend un verrou (22) apte à bloquer en rotation la bague (24) . 17. Device according to claim 15 or 16 characterized in that the connector comprises a latch (22) capable of locking in rotation the ring (24).
18. Dispositif selon la revendication 17 caractérisé en ce que le verrou (22) comprend une face sphérique (48) concave apte à venir en contact avec la face sphérique de la bague (24) .18. Device according to claim 17 characterized in that the latch (22) comprises a spherical face (48) concave capable of coming into contact with the spherical face of the ring (24).
19. Dispositif selon l'une des revendications 2 à 18 caractérisé en ce que l'un des connecteurs (12,16) est adjacent à l'assemblage à pignon et vis sans fin.19. Device according to one of claims 2 to 18 characterized in that one of the connectors (12,16) is adjacent to the pinion and worm assembly.
20. Dispositif selon la revendication 19 caractérisé en ce que la vis sans fin (20) est apte à être reçue à rotation dans le connecteur. 20. Device according to claim 19 characterized in that the worm (20) is adapted to be received in rotation in the connector.
21. Dispositif selon l'une des revendications 1 à 18 caractérisé en ce qu'il comporte en outre un instrument (100), en vue de la manœuvre de la vis sans fin, apte à recevoir à rotation la vis sans fin (200) .21. Device according to one of claims 1 to 18 characterized in that it further comprises an instrument (100), for the operation of the worm, capable of receiving the worm (200) in rotation .
22. Dispositif selon la revendication 21 caractérisé en ce que l'instrument (100) comprend un crochet (720) bifide, délimitant un espace (780) , apte à recevoir la tige (14; 140) et le pignon (18) rigidement solidaire de la tige.22. Device according to claim 21 characterized in that the instrument (100) comprises a bifurcated hook (720) delimiting a space (780), capable of receiving the rod (14; 140) and the pinion (18) rigidly secured of the stem.
23. Système d' ostéosynthèse rachidienne comprenant deux organes d'ancrage vertébral, caractérisé en ce qu'il comprend un dispositif de distraction et/ou de contraction selon l'une quelconque des revendications précédentes.23. Spinal osteosynthesis system comprising two vertebral anchoring members, characterized in that it includes a distraction and / or contraction according to any one of the preceding claims.
24. Système selon la revendication 23 caractérisé en ce que l'un des connecteurs (12,16) est apte à former une liaison rotule avec l'organe d'ancrage vertébral (2) associé .24. The system of claim 23 characterized in that one of the connectors (12,16) is capable of forming a ball joint with the associated vertebral anchoring member (2).
25. Système selon la revendication 24 caractérisé en ce que la bague (24) est apte à être montée sur l'organe d'ancrage vertébral (2). 25. The system of claim 24 characterized in that the ring (24) is adapted to be mounted on the vertebral anchoring member (2).
PCT/FR2000/000414 1999-02-18 2000-02-18 Distraction/contraction device for backbone osteosynthesis WO2000048523A1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
EP00906430A EP1152704B1 (en) 1999-02-18 2000-02-18 Distraction/contraction device for backbone osteosynthesis
KR1020017010447A KR20010102212A (en) 1999-02-18 2000-02-18 Distraction/contraction device for backbone osteosynthesis
JP2000599318A JP2002537015A (en) 1999-02-18 2000-02-18 Distraction / contraction device for spinal osteosynthesis system
AT00906430T ATE275878T1 (en) 1999-02-18 2000-02-18 DISTRACTION/SHORTENING DEVICE FOR A SPINAL OSTEOSYNTHESIS SYSTEM
AU28109/00A AU766743B2 (en) 1999-02-18 2000-02-18 Distraction/contraction device for backbone osteosynthesis
US09/913,692 US6749613B1 (en) 1999-02-18 2000-02-18 Distraction/contraction device for spinal osteosynthesis system
DE60013776T DE60013776T2 (en) 1999-02-18 2000-02-18 DISTRACTION / REDUCTION DEVICE FOR A SPHERICAL COLUMN OSTEOSYNTHESIS SYSTEM
CA002362247A CA2362247C (en) 1999-02-18 2000-02-18 Distraction/contraction device for backbone osteosynthesis

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR9901987A FR2789886B1 (en) 1999-02-18 1999-02-18 DISTRACTION / CONTRACTION DEVICE FOR A SPINAL OSTEOSYNTHESIS SYSTEM
FR99/01987 1999-02-18

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WO2000048523A1 true WO2000048523A1 (en) 2000-08-24

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Country Status (10)

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US (1) US6749613B1 (en)
EP (1) EP1152704B1 (en)
JP (1) JP2002537015A (en)
KR (1) KR20010102212A (en)
AT (1) ATE275878T1 (en)
AU (1) AU766743B2 (en)
CA (1) CA2362247C (en)
DE (1) DE60013776T2 (en)
FR (1) FR2789886B1 (en)
WO (1) WO2000048523A1 (en)

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JP2002537015A (en) 2002-11-05
EP1152704A1 (en) 2001-11-14
DE60013776T2 (en) 2005-02-10
EP1152704B1 (en) 2004-09-15
FR2789886A1 (en) 2000-08-25
FR2789886B1 (en) 2001-07-06
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US6749613B1 (en) 2004-06-15
AU766743B2 (en) 2003-10-23
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CA2362247A1 (en) 2000-08-24
DE60013776D1 (en) 2004-10-21

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